homeowners insurance question - Page 6

Ms tyrion2 · ‎05-08-2017

@stevieb wrote:
@Ms tyrion2 wrote:
@stevieb wrote:
@Ms tyrion2 wrote:
@stevieb wrote:
Because insurance is a legalized racket and their primary goal is to not pay out on a claim. If they can get the other party's insurance to pay, so much the better.

Wrong.
Each state determines a lot of this. As others before said, there is a prescribed order of coverage. Medical payments coverage is paid regardless of fault. It's often a fairly small amount. $5000 Is common. Once that coverage is exhausted, health insurance kicks in.

I don't see any attempt to avoid payment. The different carriers are just handling the claims in proper order as prescribed by the state.
No, Not "wrong". You have your opinion and others have theirs... Perhaps you're limiting your discussion to this case, which makes sense, as this is the instance under discussion here. I'm basing my opinion on the larger experience, whereby companies will both craft a policy and then glean it when claims are made to avoid paying, citing exclusions that the average customer would have no understanding of when they took out the policy... In too many cases, customers thought they were covered but are denied based on the 'fine print' that they likely didn't even know existed and that their agent probably didn't highlight for them...

How long did you work in the insurance industry?
You are free to have an opinion, but facts are more important here.

I spent over 40 years in the claims area of insurance. Let me let you in on a little secret..
Insurance companies (HO and auto) do everything possible to FIND coverage. Regulations and Bad Faith laws are so severe that an insurance company does everything possible to cover a first party claim rather than deny it.

There is very little "fine print" in an auto or HO insurance policy these days. States also regulate that.

Health insurance is a different animal when it comes to denials of coverage and not the subject of this thread.

There seems to be some confusion about liability claims and medical payments coverage here . To prevail in a liability action one must prove negligence on the homeowner's or driver's part. Medical payments coverage in an auto or HO policy pays for injuries sustained by a passenger in your car or person on your property without there being any negligence on the policyholder's part.

Order of payment between medical payments coverage and health insurance is prescribed by the state or by policy language. Health insurance is almost always secondary when there is other insurance.

Homeowner insurance clains aren't limited to slip and fall claims and medpay claims, which generally are more fairly managed... There are lots of reasons a homeowner might need to access their homeowner's policy and regardless of how long you might have worked in the industry, there are countless claims being denied for a variety of reasons... The bad faith provisions were made necessary for this very reason and while they've addressed some abuses, there are questions as to whether or not they went far enough...

Whatever.

🙄

Lipstickdiva · ‎03-10-2010

I cannot imagine a hospital getting involved in this situation. Whenever I've had to go to a hospital, urgent care or doctor to be treated for something, it is run under my own medical insurance. My insurance will then contact me and ask me questions about the incident to find out exactly how and wear it happened.

If my insurance company feels it's the responsibility of a third party to pay my bills, they will look to be reimbursed for what they have paid or they will deny the claims and tell me it needs to be submitted to the responsible party's insurance company. That insurance company can refuse to pay and then it's a fight between the 2 insurance companies and a possible lawsuit.

You don't get to decide whose insurance is going to pay. You might think it was an accident and not the fault of the homeowner but your insurance company might think differently and deny to pay claims.

stevieb · ‎03-10-2010

@Ms tyrion2 wrote:
@stevieb wrote:
@Ms tyrion2 wrote:
@stevieb wrote:
@Ms tyrion2 wrote:
@stevieb wrote:
Because insurance is a legalized racket and their primary goal is to not pay out on a claim. If they can get the other party's insurance to pay, so much the better.

Wrong.
Each state determines a lot of this. As others before said, there is a prescribed order of coverage. Medical payments coverage is paid regardless of fault. It's often a fairly small amount. $5000 Is common. Once that coverage is exhausted, health insurance kicks in.

I don't see any attempt to avoid payment. The different carriers are just handling the claims in proper order as prescribed by the state.
No, Not "wrong". You have your opinion and others have theirs... Perhaps you're limiting your discussion to this case, which makes sense, as this is the instance under discussion here. I'm basing my opinion on the larger experience, whereby companies will both craft a policy and then glean it when claims are made to avoid paying, citing exclusions that the average customer would have no understanding of when they took out the policy... In too many cases, customers thought they were covered but are denied based on the 'fine print' that they likely didn't even know existed and that their agent probably didn't highlight for them...

How long did you work in the insurance industry?
You are free to have an opinion, but facts are more important here.

I spent over 40 years in the claims area of insurance. Let me let you in on a little secret..
Insurance companies (HO and auto) do everything possible to FIND coverage. Regulations and Bad Faith laws are so severe that an insurance company does everything possible to cover a first party claim rather than deny it.

There is very little "fine print" in an auto or HO insurance policy these days. States also regulate that.

Health insurance is a different animal when it comes to denials of coverage and not the subject of this thread.

There seems to be some confusion about liability claims and medical payments coverage here . To prevail in a liability action one must prove negligence on the homeowner's or driver's part. Medical payments coverage in an auto or HO policy pays for injuries sustained by a passenger in your car or person on your property without there being any negligence on the policyholder's part.

Order of payment between medical payments coverage and health insurance is prescribed by the state or by policy language. Health insurance is almost always secondary when there is other insurance.

Homeowner insurance clains aren't limited to slip and fall claims and medpay claims, which generally are more fairly managed... There are lots of reasons a homeowner might need to access their homeowner's policy and regardless of how long you might have worked in the industry, there are countless claims being denied for a variety of reasons... The bad faith provisions were made necessary for this very reason and while they've addressed some abuses, there are questions as to whether or not they went far enough...

Whatever.

🙄

Yep... whatever...

Image result for woman shrugging gif

In my pantry with my cupcakes...

Lynnster67 · ‎08-18-2015

Yes, this practice is normal.

1. My best friend at work's son was hit by a neighbor whilst riding his bike. He had to be airlifted to university hospital, had multiple surgeries, etc. - if he hadn't been wearing his bike helmet, he probably would have dies. The medical bills were well into 6 figures. Then her insurance company went after the neighbor to be recouped from their insurance policies. There was debate over whether it should come from auto, home, umbrella, or some combination thereof. Needless to say, my friend is no longer on speaking terms w/that neighbor!

2. I tore my rotator cuff after falling down the stairs at home. After everything was paid for, my insurance co asked questions about when/how it happened, presumably so they could go after another responsible party.

Lynnster67 · ‎08-18-2015

@bonnielu wrote:
Had a thought... with these kinds of rules what is stopping someone from coming to your front door and pretend to trip there and get coverage from you. They were uninvited and they could have had a prior injury and just want someone to pay. I GUESS I WATCH TOO MUCH TV SUCH AS AMERICAN GREED.

I do know that when our tree fell in a storm on my neighbors property my insurance company told me that THEY HAD TO CALL AND HAVE THEIR INSURANCE POLICY COVER IT. My property is my responsibility and theirs was their responsibility.

That's why you need $1M umbrella insurance policy.

The law here in MD is whoever's property the tree lands on is responsible ... unless the owner of the tree was negligent and should have known the tree was in such poor condition that it should have been removed.

Lynnster67 · ‎08-18-2015

Something similar happened w/neighbor. A tree on common property looked like it was going to fall down toward her townhome so she contacted our HOA's mgmt company. They claimed it wasn't on common property (despite the fact they have had a multi-yr project to assess health of trees on common property so the dead/ailing ones can be removed before they cause damage), so she got her insurance company and attorney ex-husband involved to cover her [posterior] and copied them on everything.

Another neighbor had an issue w/tree roots on common property getting into her water/sewer line and she had quite the hassle w/mgmt company also.

No one wants to take responsibility to pay for anything.

Lipstickdiva · ‎03-10-2010

@Isobel Archer, a number of years ago, we had some friends over and they went into our hot tub and were drinking. Not gotting blitzed, had a couple of cocktails. One of the guys got out to use the restroom and when he walked into our house, he got dizzy and fell, presumably from the heat of the hot tub. He hit his head on our table and had to go to the hospital for stitches.

Our homeowners insurance did not pay for that. His medical insurance did. It was never even presented to our insurance company.

aggravated · ‎03-12-2010

@bonnielu wrote:
Had a thought... with these kinds of rules what is stopping someone from coming to your front door and pretend to trip there and get coverage from you. They were uninvited and they could have had a prior injury and just want someone to pay. I GUESS I WATCH TOO MUCH TV SUCH AS AMERICAN GREED.

I do know that when our tree fell in a storm on my neighbors property my insurance company told me that THEY HAD TO CALL AND HAVE THEIR INSURANCE POLICY COVER IT. My property is my responsibility and theirs was their responsibility.

Yes, Matlock had an interesting story about someone who fell down his porch stairs and exposing the flim-flam man. Nothing new.

tends2dogs · ‎05-08-2010

@deepwaterdotter wrote:
@Sooner wrote:
Don't know the answer but everyone should have a big liability policy for just such an incident. We have one in addition to our home owners policy.
We do too.

We do, too. It is called an Umbrella policy.

Fear not Brothers and Sisters! I have read THE BOOK..........we win!!!

Abrowneyegirl · ‎03-15-2010

I am starting to notice that those of WITH insurance need to be insured to maximum with riders and umbrella policies and so forth and yet there is a whole other group out there with the attitude that "someone else" will pay and have no insurance!

It is so frustrating.

I listened yesterday to a young lady swear and complain that loan company should "not be allow to MAKE her car insurance, it is none or her business." ?!??!??!?! I had to bite my tongue.